Predictive Value of Neutrophil/Lymphocyte Ratio for Efficacy of Preoperative Chemotherapy in Triple-Negative Breast Cancer

Abstract

BackgroundThe neutrophil/lymphocyte ratio (NLR) has been reportedly associated with prognosis in cancer patients by influencing both cancer progression and chemosensitivity. However, the correlation between NLR and the outcome of neoadjuvant chemotherapy (NAC) in breast cancer patients remains unclear.MethodsNLR was evaluated in 177 patients with breast cancer treated with NAC with 5-fluorouracil, epirubicin, and cyclophosphamide, followed by weekly paclitaxel and subsequent curative surgery. The correlation between NLR and prognosis, including the efficacy of NAC, was evaluated retrospectively.Results NLR ranged from 0.5 to 10.6. Fifty-eight patients with low NLR (<3.0) had a higher pathological complete response (pCR) rate (p < 0.001) and were more frequently diagnosed with ER-negative/progesterone receptor (PR)-negative/HER2-negative (triple-negative) breast cancer (TNBC; p < 0.001) compared with patients with high NLR (≥3.0). Among TNBC patients who achieved pCR, disease-free survival (p = 0.006) and overall survival (p < 0.001) were significantly longer in patients with low NLR than in those with high NLR. Low NLR was associated with a significantly favorable prognosis in TNBC patients who achieved pCR, according to univariate analysis (p = 0.044, hazard ratio = 0.06).ConclusionsLow NLR may indicate high efficacy and favorable outcome after NAC in patients with TNBC.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-015-4934-0) contains supplementary material, which is available to authorized users.

Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis

“…Two studies had significant age differences between arms and no clear model adjustment for age, including one study where patients were significantly older in the arm with low NLR [9] and one study where the same group was significantly younger [12]. Another study did not report the median age in each arm and did not adjust for age in the multivariable model [10].…”

“…There was a low–moderate risk of bias for the study participation domain due to lack of completeness in description of the baseline study sample in three studies [8, 13, 14]. Risk of bias was moderate with regards to study confounding, because four studies failed to adequately detail covariates included in adjusted models [8, 10, 12, 15]. …”

Neutrophil–Lymphocyte Ratio Predicts Response to Chemotherapy in Triple-Negative Breast Cancer

“…Recently, Asano et al 43 evaluated 177 patients with breast cancer who received nac and subsequent surgery, reporting that, compared with the high nlr group, the lower nlr group (<3) experienced a higher pcr rate (p < 0.001). Their study included 61 patients with tnbc, and 72.2% of the tnbc patients with a low nlr (26 of 36) experienced a pcr after nac.…”

The metastasis suppressor RARRES3 as an endogenous inhibitor of the immunoproteasome expression in breast cancer cells

“…This scenario has similarities with a mouse model of spontaneous breast cancer metastasis in which IL-1β acts as a trigger for tumor-induced neutrophil expansion, and polarization of neutrophils towards a CD8 + T cell-suppressive phenotype46. The authors of this study suggest that neutrophils promote breast cancer metastasis, and this phenomenon is evidenced at a clinical level where, for example, a low neutrophil/lymphocyte ratio is associated with favorable prognosis in triple-negative breast cancer patients who have undergone neoadjuvant chemotherapy47. Further investigations are required to determine whether PSMB8 plays an early and fundamental role in pathological immune response via modulation of key pro-inflammatory mediators including IL-1β that, in turn, regulate dynamic ratios of pro- and anti-inflammatory immune cells.…”